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Patterns of failure after salvage head and neck surgery
Kevin J Contrera1, Chengetai R Mahomva2, Bhavya K Sharma3
1Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA.
Oral Oncology
|July 17, 2024
Summary
Salvage surgery for recurrent head and neck cancer shows poor outcomes, with high rates of second recurrence. Factors like race, age, smoking, and cancer site significantly impact survival after these procedures.
Area of Science:
- Oncology
- Surgical Oncology
- Head and Neck Surgery
Background:
- Understanding outcomes after salvage surgery for recurrent head and neck cancer is crucial, especially with advances in immunotherapy.
- This study focuses on identifying patterns of failure after salvage surgery for head and neck malignancies.
Purpose of the Study:
- To determine the patterns of failure following salvage surgery for recurrent mucosal squamous cell carcinoma.
- To evaluate factors associated with recurrence and overall survival after salvage procedures.
Main Methods:
- Retrospective cohort study of 280 patients undergoing salvage surgery for recurrent mucosal squamous cell carcinoma (1997-2018).
- Nonparametric Aalen-Johansen estimator for cumulative incidence; Kaplan-Meier method for time to recurrence (TTR) and overall survival (OS).
- Multivariable Cox proportional hazard models were used to identify associated factors.
Main Results:
- The 5-year cumulative incidence of second recurrence was 54.9%, with locoregional recurrence being twice as common as distant recurrence.
- Median TTR was 21.1 months, varying significantly by cancer site (e.g., 38.2 months for larynx/hypopharynx vs. 7.8 months for oropharynx).
- Worse OS was associated with Black race, current/former smoking, age ≥ 60 years, and prior multimodal primary therapy.
Conclusions:
- Recurrence and mortality rates after salvage surgery for head and neck cancer are substantial.
- Outcomes are particularly poor for Black patients, older individuals, smokers, and those with sinonasal or oropharyngeal cancers.
